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Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

journal contribution
posted on 2023-05-19, 06:46 authored by Tesfaye, WH, Ronald CastelinoRonald Castelino, Barbara Wimmer, Syed Razi ZaidiSyed Razi Zaidi

Introduction: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD.

Methods: Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included.

Results: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n = 19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P < .001). Polypharmacy, comorbidities, and age were identified as predictors of IP.

Conclusion: IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.

History

Publication title

International Journal of Clinical Practice

Volume

71

Issue

7

Article number

e12960

Number

e12960

Pagination

1-16

ISSN

1368-5031

Department/School

School of Pharmacy and Pharmacology

Publisher

Blackwell Publishing Ltd

Place of publication

United Kingdom

Rights statement

© 2017 John Wiley & Sons Ltd

Repository Status

  • Restricted

Socio-economic Objectives

Expanding knowledge in the health sciences

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